Hamad Medical Corporation (HMC) in Qatar submitted two performance improvement projects as part of its recent effort to earn the Trauma Distinction Award of Excellence from Accreditation Canada International (ACI). In keeping with ACI’s system focus, the projects aimed to improve trauma care in both the field and the hospital.
Improving rapid sequence intubation (RSI) rates
Qatari paramedics had an RSI success rate of 86% and a post-RSI mechanical ventilation rate of 83%. The goal of the project was to increase both rates to greater than 95%. According to Holly Hepp, MSN, trauma program manager at HMC, project leaders implemented the following interventions:
- Creation of an in-house airway registry to track intubation success rates
- Strict auditing of every critical care airway intervention
- Intensive re-training of paramedics and their assistants using high-fidelity simulation as well as mental modeling
- Introduction of a video laryngoscope (GlideScope®) for potentially difficult airways
- Daily management reports on any failed RSI or RSI without mechanical ventilation
These interventions led to significant improvements in paramedic performance. The RSI success rate increased to 96% and the rate of successful mechanical ventilation following RSI increased to 98%.
Reducing missed injury rates 4 years in a row
In 2010 the trauma surgery service at Hamad General Hospital started a performance improvement process aimed at reducing the risk of missed injuries. As part of this process, the service performs a tertiary trauma survey (TTS) within 24 hours of admission for every hospitalized injured patient.
“The TTS includes the repetition of primary and secondary surveys, along with review of laboratory data, radiographic studies and the medical record, with emphasis on mechanism of injury and co-morbid factors as well as the plan of care,” said Dr. Hassan Al Thani, MBBCh, chair of Trauma Surgery and Vascular Surgery at Hamad General Hospital. Trauma team staff monitor and report TTS results daily, and TTS completion rates exceed 95%.
Published literature suggests an international missed injury benchmark rate of 1.5%. Since the start of the missed injury project, Hamad General Hospital has improved its performance for four consecutive years. Missed injury rates were 0.7% in 2010; 0.5% in 2011; 0.4% in 2012; 0.2% in 2013.
“Reducing the risk of missed injuries improves trauma patient outcomes, reduces hospital stay and costs, and improves patient and family satisfaction,” Dr. Al Thani said.